Numerical Analysis Applying the Finite Element Method by Developing a Complex Three-Dimensional Biomodel of the Biological Tissues of the Elbow Joint Using Computerized Axial Tomography

Round 1

Reviewer 1 Report

The manuscript under review focuses on the numerical analysis of biomodels for the elbow joint biomechanics, involving the humerus, radius, and ulna, along with ligaments. The authors evaluate the mechanical properties of these biomodels and analyze stress and strain distributions through the application of compressive loads. The study claims to aid in identifying structural issues and pain locations, contributing to diagnosis and improving our understanding of human biomechanics.

However, after careful examination, I regret to recommend the rejection of this thesis for the following reasons:

Lack of Specificity and Conciseness: The purpose and direction of the study are presented in overly general terms, and the methodology lacks the necessary depth and specificity. To enhance the scientific significance of the research, the authors should explore a broader range of biomechanical scenarios and simulate various situations that involve compressive loads. The current manuscript feels more like a technical report on analysis methods utilizing computer programs rather than a comprehensive research study.

Inadequate Study Sequence Description: To ensure clarity and comprehension, the authors must provide a more detailed study sequence. This should include a step-by-step recording of the program name, version, and evaluation condition methods, including precise points where compressive loads are applied. Such information is essential for readers to follow and replicate the interpretation of the results.

Insufficient Interpretation of Results: The presentation of mechanical property results (total elastic strain, Von Mises' stress, total displacement) is limited to figures and tables with numerical values only. To strengthen the manuscript's impact, the authors should provide a more comprehensive discussion of the medical diagnosis implications of these results and clarify the structural insights that can be derived from them. By doing so, the practical significance of the findings would be better demonstrated.

In conclusion, while the manuscript addresses a significant topic, it requires substantial revisions to address the aforementioned concerns and improve its overall quality. I recommend that the authors extensively revise and enhance the manuscript to address these issues before reconsidering it for potential acceptance.

Author Response

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Author Response File: Author Response.docx

Reviewer 2 Report

The article presents numerical analysis using the finite element method by developing a complex three-dimensional biomodel of biological tissues of the elbow joint using computed tomography.

The article is an interesting approach regarding the application of computed tomography and the finite element method. Nevertheless, in numerical methods, the accuracy of the model being built is also important to the physical model and considering the numerical errors (accuracy) of the method used.

Minor remarks:

1) I propose to describe in more detail on what basis and what results in the scope of selection and selection of the tool for the analyzed research problem.

2) The authors could refer to other methods that are used to build this type of model. What specific solutions are better than other jobs?

3) What features of the presented work prove its originality in the represented field?

Author Response

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Author Response File: Author Response.docx

Reviewer 3 Report

The reviewed work aims to describe the development and refinement of a biomodel that resembles the constraints associated with the humerus, radius, and ulnar structural assembly to serve as an effective and tunable disease model.  While the majority of the text reads well there are portions that demonstrate slight grammatical/English errors and convoluted sentence strucuture that could use additional attention by authors and editorial staff.  The overall model design for this project is certainly interesting and well demonstrated in the accompanying graphics; however, the overall discussion of model parameters and potential built-in biases could use additional text.  Similarly the rationale for implementation of such a model would benefit from future discussion that includes references for use of this type of biomodel design in biomedical sciences.

Below are general comments for this article:

- (Line 93-96) The statement concerning the need to manually or automatically insert/generate ligament connective points and structures appears to represent a potential point of bias since these vital elastic structures could significantly alter the performance of the resulting biomodel.  Can the authors provide further rationale or explanation for how this biasing of the model can be addressed or accounted for?

- (Figure 4) The chosen threshold for selecting skeletal architecture from CT images appears to be shown in figure 4 but I am not readily finding this range information in the text.  Could the author please highlight this data as this range is important for establishing the bulk structure of the core architecture of the biomodel.

- (Line 170-172) When saving the initial file as an STL format is there a record for the mesh density that was chosen for the output 3D object?  This initial file resolution can be critical for downstream processes in the Finite Element Method computing since it establishes the starting surface faces that the software can use.

- The figure within this article are highly effective at conveying the overall construction and design of the described biomodel.

- Additional details concerning the initial design and biomodel construction parameters would be helpful.

- (Line 439-442) While the biomodel would be an effective means for generating a more personalized design for such prosthetics, the limitations of 3D printing for such an approach more commonly falls to material selection as it relates to biocompatibility and strength.  Reconstruction of the ultra-structure for these skeletal components could also likely be performed using images slices from a unidirectional CT scan.

Based on these comments, it is the opinion of this reviewer that the associated article is of interest to the scientific community and shows strength in its design but could benefit from minor revisions to highlight portions related to biomodel development and downstream application potential.

While the majority of the text reads well there are portions that demonstrate slight grammatical/English errors and convoluted sentence strucuture that could use additional attention by authors and editorial staff.

Author Response

Please see the attachment

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

It seems that the manuscript was edited as much as possible by taking the opinions of reviewers. I agree to accept this manuscript.